Four Square Step Test

Assess your patient’s dynamic balance and coordination with the Four Square Step Test (FSST). Click here to get a free template and guide!

By Patricia Buenaventura on Apr 08, 2024.

Fact Checked by Nate Lacson.

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What is a Four Square Step Test (FSST)?

A or FSST is an effective tool practitioners use to measure their patient’s balance, coordination, dynamic stability, mobility, and fall risk. To assess, patients are required to step over a cane or rod while moving forward, sideways, and backward. It is one of the quickest and most reliable tests used by practitioners for older patients, those with vestibular disorders, stroke, and more.

Though there exist diagrams and videos of how to conduct the Four Square Step Test (FSST), currently, there aren’t any standardized templates practitioners can use as a reference, guide, or document where they can record a patient’s results.

Given this, for your ease and benefit, we’ve produced a Four Square Step Test (FSST) template for free download and use. In it, you can find the following:

  • Basic information such as the date of examination, patient name, and the examiner’s name
  • A diagram and directions on how to conduct the test
  • An allocated space where you can write the results and additional notes you may have

Is the Four Square Step Test (FSST) helpful for your practice? Want a copy of our template? Keep reading for more details and a step-by-step on downloading and using our template.

Printable Four Square Step Test

Download this Four Square Step Test to assess your patient’s dynamic balance and coordination

How does this Four Square Steps Test work? 

Step One. Download the Template 

Access and download our template by doing either of the following:

  • Click the “Download Template” or “Use this template” button above
  • Search for “Four Square Steps Test” in Carepatron’s template library on our website or app

Step Two. Conduct the Test

Before you start, don’t forget to fill out the basic information needed, such as the examination date, patient name, and your name. To add, it’s best to prepare and set up the required equipment: a stopwatch and 4 canes or rods. Feel free to check our template to know how to arrange the canes on the floor for the test. 

Once everything has been prepared, you may conduct the test by following the instructions provided on the template. For good measure, we’ve also written the directions below. 

Instructions: Explain that the goal is to step from one square to another, clockwise (1 to 2 to 3 to 4), then counterclockwise (4 to 3 to 2 to 1 OR 5 to 6 to 7 to 8 ), as fast as possible without touching the sticks. Both feet must touch the floor in each square and face forward the whole time if possible.

Step Three. Score 

Since this test must be done twice, remember to write down the results you get from each test. The final score will be the one with the better time. 

Step Four. Interpret the Results

When you have a final score, you can proceed with interpretation. If you need assistance interpreting the results, refer to the “Four Square Step Scoring” or FAQ section below. 

Four Square Step Scoring

To obtain the final Four Square Step Test score, you must first record the time (in seconds) of the first and the second go. Afterward, the one with the better time - shorter time - will be your final score.

Four Square Step Test Example (Sample)

Here’s an example of a filled-out Four Square Step Test template. Check out this sample for an idea of how this assessment may look completed. 

For an offline copy you can use for future reference, click the sample below or the “Download Example PDF” button above.

Download this Four Square Step Test Example (Sample) here:

Four Square Step Test Example (Sample)

When to use this Four Square Step assessment? 

Practitioners who need a foundation document, those who want to track progress, or train their patient’s balance, can utilize this Four Square Step assessment. More specifically, practitioners who are caring for the following patients:

  • Geriatric
  • Those who experienced or are rehabilitating from a stroke
  • Those who have Parkinson’s or vestibular disorders
  • Those who rehabilitating from limb weakness or limb loss

Benefits of the Free Four Square Step Test

Quick and Inexpensive

Since this test only requires three pieces of equipment, a stopwatch, and 2 canes or rods, and can be administered in not more than 5 minutes, it can be considered a quick and inexpensive yet still reliable way to assess your patient’s balance, dynamic stability, etc. 

Written Copies for Reference

As mentioned above, this test doesn’t have a standardized template. Therefore, our template will be useful, especially if you need a written guide, reference, or document to record your patient’s results. 

Tracks Progress

There’s no cap or maximum number of times you can conduct the test. You are free to use it to track progress, compare the change between pre-treatment and during treatment, or see the difference and effectiveness between two treatment plans. 


This test wasn’t designed with a specific practitioner in mind, making it versatile for practitioners who may need it for their practice. Furthermore, our template, in particular, is just as versatile because you can easily edit it according to your wants and needs right on Carepatron. 

Fully Digital and Accessible 

You can download our template on any gadget you have on hand and fill it up using any local PDF editor or right on Carepatron. Even better, if you store the template on Carepatron as well, you’ll be able to give and limit viewing access to relevant parties only. 

Why use this Four Square Step Test app?

Aside from being a source of a free template and guide for the Four Square Step test (FSST), Carepatron is also an application or leading practice management software where you can equip yourself with the means and tools to help you automate administrative tasks and streamline business and clinical processes. That way, most of your time, effort, and focus will go toward patient care.

If you download our application on your desktop or mobile device, regardless if it’s iOs or Android, you’ll have access to the following tools and resources for free:

  • Hundreds of downloadable, digitally editable, and printable templates of forms, surveys, tests, assessments, and other medical documents in PDF form. You can even make your own right on Carepatron.
  • A secure EHR that’s HIPAA-compliant for all your digital notes and client’s medical records
  • Integration with telehealth and multiple scheduling software
  • An automated payment system you can set up for your client

All these and more if you sign up for Carepatron today!

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What is a negative/positive Four Square Step test?
What is a negative/positive Four Square Step test?

Commonly asked questions

What is a negative/positive Four Square Step test?

If negative is equivalent to a failed test, a test has a negative result if the patient fails to do the test even after two attempts. The interpretation of this result is that the patient has an increased risk of falls. 

On the other hand, a positive test doesn’t only mean that the patient was able to do the test successfully but they must also be able to complete the test in less than 15 seconds without assistance. The interpretation then of this result is that they are not at risk for falls.

How to perform the Four Square Step Test?

To perform the Four Square Step Test, you will only need to prepare the set-up, equipment, and template for a guide on how to conduct the test. For a more comprehensive step-by-step, please refer to the “How does this Four Square Step Test” work section above.

Who developed the Four Square Step Test?

Dite and Temple developed the Four Square Step Test.

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